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The logic puzzle triggered episodes that brought about recurrent muscle spasms in the left limb.(Image credit: Peter Dazeley via Getty Images)ShareShare by:
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The subject: A male, aged 25, residing in Germany
The indications: The individual was experiencing a ski excursion during the month of November in 2008, when a snowslide rendered him senseless and entombed him under accumulated snow for a quarter of an hour. His bodily tissues were bereft of sufficient oxygen as he was caught, causing him to foster a state termed hypoxia. His companion saved him and promptly commenced artificial respiration upon extricating him from the snowy mass, Berend Feddersen, a nerve specialist affiliated with the University of Munich situated in Germany, along with the primary writer of a report concerning the circumstance, previously communicated with Live Science. Subsequently, he was transported to a medical center.
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What ensued subsequently: Subsequent to a stay within the medical facility, the man was relocated to a therapeutic center. While within this center, he initiated a sudoku challenge — a recurrent leisure activity of his preceding the impairment.
While he deciphered the sudoku, the musculature within his left upper limb repeatedly twitched. Nonetheless, these motions promptly ceased as he discontinued labor on the conundrum.
The conclusion: The individual seemingly underwent clonic fits — recurring jerking movements — within his arm during the course of sudoku solving, thereby the therapeutic squad conducted cerebrum examinations to more comprehensively grasp the ongoing phenomenon.
An electroencephalograph, which gauges action occurring along the brain’s exterior, disclosed that the patient was enduring a right centroparietal seizure configuration — signifying the fits originated from the central and parietal zones within the right hemisphere of his cerebrum. The MRI unveiled no indications of ailment or aberration potentially inciting this seizure exertion.
The therapeutic team subsequently executed a functional MRI (fMRI) upon the patient whilst he tackled a sudoku; this category of analysis monitors action across the brain through blood flow. The assessment divulged “extensive activation,” even though action within the centroparietal cortex registered especially elevated, as the physicians chronicled within an account of the occurrence. A more meticulous scrutiny utilizing a variant of MRI designated as diffusion tensor imaging, which yields outlines depicting the brain’s white-matter filaments, portrayed a scarcity of repressive fibers within this brain segment.
The diminishment of these repressive fibers — which sustain the activity of cerebral cells under control — culminated in a three-fold escalation within the nerve’s exertion coursing downward via the patient’s left arm. The medical professionals documented that the oxygen scarcity the individual underwent during the avalanche constitutes the “most probable” derivation of this harm.
Correspondingly, the augmented activation of the right centroparietal cortex precipitated localized epileptic fits, denoting fits concentrated within a singular discrete sector of the cerebrum. Specifically, the patient had fostered reflex epilepsy, wherein fits are stimulated via particular stimuli, such as precise illuminations or musicality.
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Within this occurrence, the three-dimensional tableau the patient envisaged whilst resolving sudoku ignited the seizures, stated Feddersen. The patient failed to undergo clonic seizures whilst perusing, scripting, or computing. However, the clinicians possessed the ability to prompt a seizure via furnishing the man with supplementary visual-spatial undertakings, for example, sequencing an arbitrary concatenation of numerical values in ordinance from the minimal to the maximal.
The management: The patient garnered a prescription of anti-epileptic pharmaceutical intervention, which terminated his seizures; he endured surpassing five years devoid of seizures as of 2015, as communicated within the report. Furthermore, he underwent physiotherapy, which alleviated the contractions he weathered whilst ambulating and vocalizing.
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He additionally ceased to tackle sudoku conundrums.
Element rendering the circumstance distinctive: Roughly 3.8% of individuals will cultivate epilepsy amidst their existence, with approximately 4% to 7% of these subjects encountering reflex seizures. Although this constituted the inaugural acknowledged instance of a sudoku conundrum initiating seizures, a prevalent iteration of reflex epilepsy bears the designation “praxis induction,” wherein visual-motor undertakings — such as participating in chess or cards — instigate muscle twitches.
For illustration, in 2015, physicians recounted the instances of five males diagnosed with epilepsy within China who manifested seizures prompted by engaging in the ancient Chinese diversion of Zipai. These males, ages ranging from 19 to 44 years of age, discontinued enduring seizures once they averted involvement in Zipai. Analogously, within the month of January in 2025, physicians stationed in Taiwan chronicled 30 patients who exhibited reflex seizures instigated through participation in Mah-Jong.
For additional intriguing medical chronicles, peruse our Diagnostic Dilemma compendium.
Disclaimer
This composition caters solely to educational intentions and is not construed for extending medicinal counsel.
TOPICSDiagnostic dilemma
Sophie BerdugoSocial Links NavigationStaff writer
Sophie functions as a U.K.-stationed staff scribe for Live Science. She encompasses a diverse array of themes, having beforehand accounted for investigations spanning from bonobo communication toward the genesis of aquatic substances within the universe. Her oeuvre has likewise materialized inside outlets inclusive of New Scientist, The Observer along with BBC Wildlife, besides she garnered a nomination for the Association of British Science Writers’ 2025 “Newcomer of the Year” laurels pertaining to her freelance efforts at New Scientist. Prior to her transition into a science columnist, she consummated a doctorate pertaining to evolutionary anthropology emanating from the University of Oxford, wherein she allocated four years inspecting why certain chimpanzees display enhanced aptitudes regarding tool utilization contrasted with others.
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